Integrating cervical cancer screening and preventive treatment with family planning and <scp>HIV</scp>‐related services

White, Heather L.; Meglioli, Alejandra; Chowdhury, Raveena; Nuccio, Olivia

doi:10.1002/ijgo.12194

Cited by 36 publications

(44 citation statements)

References 18 publications

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“…(p<0.002) following integration. These findings are consistent with other studies that registered improvements in outcomes when CACX screening was integrated with other services although not all these studies highlighted significances of these improvements [11,16,17,[23][24][25]. A possible explanation for the increased service utilisation in our study could be due to the training provided to health providers and community mobilisation agents that led to improved awareness and created more opportunities for women to access integrated services unlike before [19].…”

Section: Change In Service Utilization At Facility Level Before and Asupporting

confidence: 91%

“…Evidence regarding what works and does not work in integrating care such as CACX screening being integrated with FP in environments out of HIV context is limited [14,16]. Integrating CACX screening into FP service provision in Zambia was reported to be feasible much as uptake of both services was low [11].…”

Section: Introductionmentioning

confidence: 99%

“…A systemic review using five databases of studies that had evaluated integration of FP with other health services also revealed that the evidence to support the integration of FP with other health services was still weak [17]. More research about the outcomes of health service integration has been recommended [11,16,18].…”

Section: Introductionmentioning

confidence: 99%

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Effect of service integration on cervical cancer screening and family planning uptake: A uncontrolled before and after facility study in Mukono District, Uganda.

Maureen¹,

Ssennyonjo

Kiwanuka

2019

Preprint

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Background Cervical cancer (CACX) is the third most common cancer among women globally yet it is largely preventable. Uganda has one of the highest age standardized CACX incidence rates in the world yet it has a low screening rate ranging from 4.8 to 19% compared to the national target of 80%. Women using hormonal contraceptives over a long time are among the most at risk of CACX yet there is limited information about their screening status. In 2014, an integrated FP-CACX screening service model was implemented in Mukono district in Uganda to reduce this unmet need for both services. This study assessed whether an integrated model resulted into increased utilization of both services at health facilities in Mukono district.Methods Integration was defined as the uptake of both FP and CACX screening services during the same visit. Monthly quantitative data on service utilization was collected retrospectively from records at 7 health facilities, 36 months before and 27 months after the integration intervention. The period 2011 to 2013 defined years before while 2014 to 2016 were years after integration. Descriptive analyses and tests of significance were carried out and results were expressed in percentages, means and mean differences.Results Among 48595 women desiring FP or CACX screening in the 7 facilities for the period 2011 to 2016, 41374 (85%) opted to solely receive an FP service. CACX screening services were received solely by 937 (2%) women while 6284 (13%) received integrated services. There were significant increases in the services received solely and as a combination. Integrated services increased by 15 mean clients per month (p<0.001) from a mean number of 5 (SD±14.5) to 20 (SD±26.9) clients per month in 2016 after integration.Conclusion Integrating CACX screening with FP service provision led to significant increases in the services received solely and as a combination after integration. More research on approaches including how and when to roll out integration in different settings is needed to inform future expansion efforts for better uptake of integrated services.

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Section: Change In Service Utilization At Facility Level Before and Asupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of service integration on cervical cancer screening and family planning uptake: A uncontrolled before and after facility study in Mukono District, Uganda.

Maureen¹,

Ssennyonjo

Kiwanuka

2019

Preprint

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“…Focused and systematic analyses of health information systems in recent years have identified feasible approaches for incorporating cervical cancer indicators into routine government data systems, whether paper‐based or electronic; implementation of these approaches is now the urgent priority. Several countries and agencies have put into practice programs that integrate cervical cancer screening into existing health services, such as those for family planning and HIV/AIDS, while documenting potential benefits and remaining challenges . More such programmatic experiments are needed to identify facilitating factors and favorable environments for integration, and to learn how to ensure that established programs are not compromised and efficiencies are in fact captured.…”

Section: Proven Solutions Are Availablementioning

confidence: 99%

The investment case for cervical cancer elimination

Tsu

Ginsburg

2017

Intl J Gynecology & Obste

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This ar cle includes a [French andSpanish] transla on, available in the Suppor ng Informa on sec on.Post publica on no ce: 23 August 2017, a er fi rst online publica on: French and Spanish transla ons are made available in the Suppor ng Informa on. AbstractWe already know what causes cervical cancer, how to prevent it, and how to treat it, even in resource-constrained se ngs. Inequitable access to human papillomavirus vaccine for girls and screening and precancer treatment for women in low-and middleincome countries is unacceptable on ethical, social, and financial grounds. The burden of cervical cancer falls on the poor and extends beyond the narrow bounds of the family, affec ng na onal economic development and community life, as family resources are drained and poverty ghtens its grip. Proven solu ons are available and the priori es for the next few years are clear, as shown by the papers in this Supplement.Sustained poli cal commitment and strategic investments in cervical cancer prevenon can not only save millions of lives over the next 10 years, but can also pave the way for the broader fight against all cancers. K E Y W O R D SCervical cancer ; Disease elimina on ; Low-income countries ; Preven on | INTRODUCTIONWe already know what causes cervical cancer, how to prevent it, and how to treat it, even in resource-constrained se ngs. Yet, sadly, every two minutes a woman dies of this disease. The global divide in incidence and mortality for cervical cancer could hardly be more stark. The vast majority of women who develop and die of cervical cancer live in low-and middle-income countries (LMICs), where access to primary and secondary preven on-and care for women with invasive disease, including pallia ve care-remains profoundly limited. The problem fundamentally is social and economic inequality-the solu on is, in large part, sustained poli cal commitment.If the current genera on of young adolescent girls can be vaccinated against human papillomavirus (HPV), in 20-30 years as they reach the ages when precancerous lesions would normally appear and take hold, they can expect to be nearly free of the threat of cervical cancer. The good news about cross-protec on against HPV types not included in the vaccine and herd immunity for those who missed being vaccinated 1,2 and the recent licensing of a 9-valent vaccine that protects against 90% of the types causing cervical cancer suggests we may be closer to elimina on of this disease than we dreamed possible 10 years ago when the vaccine was first introduced. 3 Despite this exci ng prospect and the hard work it will take to make widespread HPV vaccina on a reality, we cannot forget the millions of adult women and older adolescent girls who were beyond the priority age for vaccina on when it became available in their communi es. These women deserve a chance to have the protec on that screening and preven ve treatment (for precancer) provides-the protec on women in wealthy countries have benefitted from for decades. Arguments to ra onalize this gross inequity of acces...

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“…discuss how recent advances in health information technology can address some of the challenges that beset data systems needed for both patient care and program monitoring. White et al . draw on their experience integrating cervical cancer screening into existing family planning and HIV/AIDS services to delineate the potential opportunities such integration can create, as well as the challenges that must be overcome to reap the full benefits of this approach.…”

mentioning

confidence: 99%